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NPI Code Detail

MEDICARE: JESSICA VAN NESS JACOBS LCSW

MEDICARE: JESSICA VAN NESS JACOBS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34008517AIN

General Provider Information

NPI Number : 1255733689
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA VAN NESS JACOBS LCSW
Provider Business Mailing Address
First Line : 313 WESTERN BLVD STE E
Second Line :
City : GREENWOOD
State : IN
Zip : 46142-9217
Country : US
Telephone Number : 317-426-1847
Fax Number :
Provider Business Practice Location Address
First Line : 313 WESTERN BLVD STE E
Second Line :
City : GREENWOOD
State : IN
Zip : 46142-9217
Country : US
Telephone Number : 317-426-1847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2014
Last Update Date : 01/22/2020

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